Assessment of Community-based Ivermectin Treatment Coverage for Onchocerciasis in Cameroon: The Case of Batcham Health District

Abstract

Background: Community directed treatment with ivermectin (CDTI) has led to significant reduction in the prevalence and incidence of onchocerciasis in endemic communities of Latin America and sub-Saharan Africa. At the time when the WHO targets onchocerciasis for elimination by 2030, we aimed to assess the effectiveness of CDTI in Cameroon, through the evaluation of therapeutic coverage. Method: We carried out an independent cross-sectional descriptive and analytical survey to assess and compare the actual and the reported administrative therapeutic coverages of the September 2021 CDTI in Batcham Health District (BHD) in the west region of Cameroon. Results: We included 802 participants from six health areas of the district, aged 5-96 years with a mean age of 32.4 ±18.9 years, of whom (52.4%) were female, and 54.9% had attained secondary education. About 73% of them were aware of the 2021 CDTI campaign, with major sources of information being from social gatherings (79.3%) and from the CHW (42.3%). The observed therapeutic coverage was 61.7%, significantly below the reported administrative therapeutic coverage of 90% (X2 = 21.49, OR: 5.52 (95% CI: 2.45 – 13.26), p = 0.000). Factors independently associated with adherence to CDTI were the male gender, health areas (Batcham palace, Bagang west, Batcham Fiela and Bambi), home visit by CHW for ivermectin distribution, and being present at home during ivermectin distribution. Conclusion: We found a huge deficit between the observed and the reported administrative therapeutic coverages of the 2021 CDTI in BHD. This indicates considerable weaknesses and ineffective quality assurance of CDTI activities. Reinforcement of community sensitization through social gatherings and CHW, as well as programmatic aspects such as door-to-door visits by CHW for ivermectin distribution, during periods of the day when the population is most likely to be present would improve upon adherence to CDTI and consequently therapeutic coverage.